Healthcare Provider Details

I. General information

NPI: 1457548075
Provider Name (Legal Business Name): MELISSA MAXWELL DAVIS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELISSA ANNE MAXWELL PH.D.

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17125 CAMPBELL FARM RD
POOLESVILLE MD
20837-2172
US

IV. Provider business mailing address

17125 CAMPBELL FARM RD
POOLESVILLE MD
20837-2172
US

V. Phone/Fax

Practice location:
  • Phone: 574-261-6937
  • Fax:
Mailing address:
  • Phone: 574-261-6937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number06195
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: